Laurie Grealish

Foot massage. A nursing intervention to modify the distressing symptoms of pain and nausea in patients hospitalized with cancer.

This article describes the findings of an empirical study on the use of foot massage as a nursing intervention in patients hospitalized with cancer. The study was developed from the earlier work of Ferrell-Torry and Glick (1992). In a sample of 87 subjects, a 10-minute foot massage (5 minutes per foot) was found to have a significant immediate effect on the perceptions of pain, nausea, and relaxation when measured with a visual analog scale. The use of foot massage as a complementary method is recommended as a relatively simple nursing intervention for patients experiencing nausea or pain related to the cancer experience. Further research into its effectiveness in the management of these symptoms by the family at home is warranted.

An exploratory study of first year nursing students' learning in the clinical workplace.

Abstract This study explored how first year undergraduate nursing students learn in clinical placements as part of a program informed by Wenger’s (1998) social theory of learning. Forty-nine written student narrative accounts of a learning experience were analysed and three triggers for learning were identified. The first trigger is that participation (or observation) of a task or procedure leads students into a complex, dramatic reading of nursing work. The second is that when students are personally (emotionally) confronted by the work, it presents a high challenge situation, recognized by students as a significant learning opportunity. The third trigger is encounters with different nurses assist students to construct an image of what they want to be as a nurse. These three triggers appear to align with Wenger’s Communities of Practice constructs for identity, engagement, imagination, and alignment, and provides preliminary evidence supportive of the social theory of learning for nursing students on clinical placement.

Developing a professional identity: Student nurses in the workplace.

Abstract This analysis of the academic and student discourse about learning in the practicum in one Australian pre-registration Bachelor of Nursing course is part of a larger study examining the professional identity of undergraduate students in three professional groups: nursing, teaching and engineering. The focus group discussion of six student nurses reveals that the theories learned in the classroom are only partially useful preparation for the relationships required to work as a nurse in a people-laden workplace; students struggle to create meaning about practices that are not consistent with classroom theory; and students require support as they develop an identity of a nurse through the embodiment of practice work. The findings from this group support the view that the traditional approach to learning, as expressed in the documentation for the final practicum experience, where knowledge is certain, context-free, and disciplinary or subject focused, is insufficient to assist student readiness for the world of work. Recommendations emerging from this analysis are related to the university and provides some evidence for others teaching in nursing programs to reconsider their practices.

Theory before practice: implicit assumptions about clinical nursing education in Australia as revealed through a shared critical reflection

Abstract The transfer of nursing education into the higher education sector occurred over a 10-year period in Australia (1985–1994). Australian nurse leaders settled on a single outcome measure to be applied for all nursing graduates in the form of national competency standards. While this move enabled diversity, the lack of consistency in curriculum design has subsequently led to increasing confusion for clinicians who support students’ learning in clinical placements. Using a shared critical reflection method, the authors reviewed (1) the evaluation comments from nurses in one nursing unit of a hospital in one Australian jurisdiction and (2) an historical review of nursing literature at the time of the transfer of nursing education into the higher education sector. The reflection suggests that the aim of the transfer, to create critical thinking graduates, has been undermined by the implicit clinical education practices that have since emerged. In order to address the contemporary challenges for clinical staff working with students from multiple universities, as well as increased student numbers to address the nursing shortage, we recommend a new approach to curriculum design: a national clinical curriculum drawn from social, as well as cognitive, learning theory that at once informs clinicians of students’ potential abilities and provides the scope to accommodate the increasingly difficult and critical learning requirements of tertiary-based nursing students.

Potentially preventable complications of urinary tract infections, pressure areas, pneumonia, and delirium in hospitalised dementia patients: retrospective cohort study

Objectives To identify rates of potentially preventable complications for dementia patients compared with non-dementia patients. Design Retrospective cohort design using hospital discharge data for dementia patients, case matched on sex, age, comorbidity and surgical status on a 1 : 4 ratio to non-dementia patients. Setting Public hospital discharge data from the state of New South Wales, Australia for 2006/2007. Participants 426 276 overnight hospital episodes for patients aged 50 and above (census sample). Main outcome measures Rates of preventable complications, with episode-level risk adjustment for 12 complications that are known to be sensitive to nursing care. Results Controlling for age and comorbidities, surgical dementia patients had higher rates than non-dementia patients in seven of the 12 complications: urinary tract infections, pressure ulcers, delirium, pneumonia, physiological and metabolic derangement (all at p<0.0001), sepsis and failure to rescue (at p<0.05). Medical dementia patients also had higher rates of these complications than did non-dementia patients. The highest rates and highest relative risk for dementia patients compared with non-dementia patients, in both medical and surgical populations, were found in four common complications: urinary tract infections, pressure areas, pneumonia and delirium. Conclusions Compared with non-dementia patients, hospitalised dementia patients have higher rates of potentially preventable complications that might be responsive to nursing interventions.

Clinical education delivery – A collaborative, shared governance model provides a framework for planning, implementation and evaluation

Following a scheduled review of a university pre-registration Bachelor of Nursing program, a decision was taken to introduce a new model of clinical education delivery. Principles of collaboration, as used by other university nursing programs, were applied to the change management process. As the process of change progressed, a model incorporating collaboration and shared govemance emerged to address the challenge posed by multiple stakeholders from culturally different organisations and the genuine commitment by those stakeholders to share contol in the planning, implementation, and evaluation of the clinical education delivery model. Using a case study approach, this article demonstrates how the principles of collaboration and shared governance were combined to effectively manage change in the delivery of clinical education across several different organisations, aind provides an extended framework for collabortive change management involving multiple stakeholders.

Practice-Based Learning in Higher Education: Jostling Cultures

The collection of papers that comprise this edited monograph addresses issues confronting universities’ attempts to integrate practice-based learning in higher education curriculum. It is through accounts and analyses of activities that the kinds and extents of this jostling of cultures within and amongst the academy, industry, government and professional bodies and other educational providers become evident. The contributions, in different ways, engage theory in practices (Price et al.2009) through appraisals of a range of issues in the recognition and implementation of practice based learning initiatives. The contributions explore the epistemologies, structures, politics, histories and rituals that both support and constrain opportunity and success in students’ experiences, and illuminating the issues, practices and factors that shape the processes and outcome of educational efforts to integrate experiences in both practice and educational settings, each of which has their own distinct cultures, practice within their communities (Gherardi 2009).

Aged care facilities and primary health-care clinics provide appropriate settings for dietetic students to demonstrate individual case management clinical competence

Aim The aims of this study were to: (i) determine the ways in which non-hospital placement settings are used for individual case management clinical placements in dietetic education and (ii) examine the extent to which students can develop individual case management clinical competencies in non-hospital placement settings. Methods A sequential mixed methods approach was used. Quantitative data were obtained from an online questionnaire conducted with placement coordinators from all 15 Australian universities with accredited dietetics programs. Qualitative data were obtained from a focus group with eight experienced clinical supervisors who had viewed 11 audiovisual recordings of student/dietitian encounters with clients in non-hospital settings and assessed them against entry-level competencies. Data were analysed using descriptive statistics and content analysis. Results Placement coordinators from 10 of the 15 accredited universities responded, with most universities (8/10) using hospitals for the majority of their individual case management clinical placements. Seven of the ten universities used non-hospital settings but only for a small proportion of students (=25%) and for short durations (one to two weeks). The experienced clinical supervisors agreed that primary health-care clinics and residential aged care facilities provided appropriate practice settings for student dietitians to demonstrate individual case management clinical competencies. Conclusions To align with the national health-care agenda and workforce demands, this research supports the expansion of clinical placement settings to also include non-hospital settings. The influence of context on competency development requires adjustments to be made for the nuanced practice differences in these settings.

Characteristics of rural hospital services for people with dementia: Findings from the Hospital Dementia Services Project

OBJECTIVE To obtain information about aged care services in rural New South Wales public hospitals, and to describe key operational aspects of their service delivery models. DESIGN A mixed methods design was used to combine data collected from: (i) a survey of public hospitals and (ii) qualitative site visits in a sample of eleven rural sites. SETTING Rural public hospitals in NSW, Australia. PARTICIPANTS Qualitative data were collected from multidisciplinary clinicians, managers and community service providers who participated in site visits in 2010 and from surveys of NSW public hospitals in 2009/10 about aged care and dementia services. RESULTS Survey and site visit findings demonstrated that rural hospitals have fewer secure beds for managing patients with disturbed behaviour due to dementia and delirium and fewer speciality aged care staff than metropolitan hospitals. Site visit participants also described how secure environments can aid care for people with dementia even in the absence of clinical specialists. CONCLUSION The care of people with dementia in rural hospitals is constrained by access to specialist aged care staff and the physical environment of the hospital. Clinicians are adept at maximising resources to manage diagnosis and transitions for people with dementia. Further understanding of how key operational aspects of clinical leadership and environmental modifications impact on a range of patient outcomes would be valuable.

Interprofessional education in practice: Evaluation of a work integrated aged care program

Health professional clinical education is commonly conducted in single discipline modes, thus limiting student collaboration skills. Aged care residential facilities, due to the chronic and complex health care needs of residents, provide an ideal placement to provide a collaborative experience. Interprofessional education is widely acknowledged as the pedagogical framework through which to facilitate collaboration. The aim of the evaluation was to assess student attitudes towards collaboration after active involvement in an interprofessional education program. Students studying nursing, occupational therapy, and aged care were invited to complete a version of the Readiness for Interprofessional Learning Scale before and after participating in a three-week pilot interprofessional program. A positive change in student attitudes towards other health professionals and the importance of working in interprofessional teams was reported with significant differences between two statements indicated: Learning with health-care students before qualifications would improve relationships after qualifications; and I learned a lot from the students from the other disciplines. The innovative pilot project was found to enhance student learning in interprofessional teams and the aged care environment. Further development of this and similar interprofessional programs is required to develop sustainable student projects that have health benefits for residents in aged care residential facilities.